Over the past seven years, the Mesa Fire and Medical Department has taken the lead nationally in seeking ways to cut the cost of 911 medical calls.

It began with what the department called transitional response vehicles, two-person trucks responding to non-critical situations, as opposed to sending a full fire rig every time.

Later, the program added nurse practioners from Mountain Vista Medical Center to provide enhanced care. And last year it began including specialists from CPR Behavioral Health.

Mesa now calls these trucks "community care response units."

The savings have cut several ways. For the city, the increased efficiency has been the equivalent of adding a fully equipped 24/7 fire company. And for patients and their insurers, the emergency-room and other hospital costs can be far lower.

But there is a public cost, and Mesa will now be looking for ways to get some of that money back.

The City Council's public-safety panel gave the green light recently for the Fire Department to draft an ordinance that would allow it to bill insurance companies or private health-care providers for some services.

Fire Chief Harry Beck said Mesa would not bill in every case because most of those claims would have to be paid by other government entities, such as Medicaid or the state health insurance system.

"I don't want to mislead you with cost recovery because I don't intend for it to be 100 percent," Beck told the committee on June 12. "There will be some revenue to offset the ongoing costs of that type of program."

He added, "We're not intending to make money in this. There is simply an opportunity for us to offset costs for something that we would be doing anyway."

Assistant Fire Chief Mary Cameli said Mountain Vista and CPR already have the ability to bill for the work they do with the department.

She was careful to note that Mesa would not bill for every service that typically accompanies a 911 medical call. Most often, the bill would be for non-emergency transport to a behavioral-care facility.

Cameli said demand for behavioral health services is soaring.

"We used to get three to five a day and now we get 10 to 12 a day," she said. "The hospitals are getting really overcrowded and flooded with behavioral holds."

It's not uncommon for a behavioral patient to stay in a hospital two or three days, racking up enormous bills, before he or she can be referred to a mental-health facility. In one recent case, Cameli said, a child spent 12 days in a hospital before being sent to an appropriate care center.

The Fire Department's behavioral health unit can take such patients to proper facilities directly, bypassing the ER.

Cameli said both of the community care trucks are stationed in downtown Mesa because that's where most of the calls come from, but the service is available citywide.

She said Mesa should hear by the end of this month whether it will receive a $13.7 million federal grant for which it applied last year to expand the programs. With that money, the city would field three nurse-practioner units and one behavioral unit 24 hours a day. The trial would last three years.

Mesa believes there is a federal interest in the program under the Affordable Care Act. If the city can prove that the community care units reduce medical bills, there could be federal backing to roll out similar programs nationwide.

"Life used to be simple when it was one size fits all" in terms of 911 medical responses, Beck said. "But it's not very efficient. So we have in the last five years, since TRVs were approved by council, been exploring other ways and other opportunities. We're basically inventing a new model out of thin air."